Spreading the Wealth
Since it appears that America is headed towards obligatory Socialism courtesy of our imminent Democrat overlords, I have come up with a plan to spread the wealth in the Emergency Department. Instead of providing excellent medical care to the relatively few patients who are fortunate to receive my outstanding personal attention, I have decided that after the election I will redistribute my efforts so that I can provide average care to a few more patients per shift. I don't mind lowering my standards for the benefit of society as a whole, and hopefully the patients who wanted superior medical treatment will be satisfied with the assembly line experience instead. If they are patriotic, they will understand.It seems that the sickest 5% of patients are taking up entirely too much of my time, so I'm going to stop giving so much attention to those with heart attacks and strokes. I just want to make sure that everybody who is behind them with chronic back pain or poison ivy, that they've got a chance too. They shouldn't have to wait longer to be seen just because they were triaged to a lower acuity level. My attitude is that if the ER is good for folks from the bottom up, it's gonna be good for everybody.
I've decided to be more generous with narcotics as well. Instead of giving the most narcotics to those relatively few patients with severe trauma or kidney stones, I'm going to redistribute some of those opiates to patients with conditions like migraines or fibromyalgia instead. The guy with the broken femur is still going to get his shot, but he's going to have to give up a piece of his pie so that the homeless lady with a toothache can have a piece. That should be good for a bump in my Press Ganey polls. How many people really break their femurs, anyway? None in my neighborhood.
I can't wait to see how my new ideas are going to work out. After all these years of failed, misguided, and unjust policies, it's definitely time for a change in the ER. And those of us who have experienced the agony of a bad toothache can agree...we are the ones we've been waiting for. For the first time in my adult life, I'm going to be proud of my profession.
posted by scalpel at 9:54 PM
67 Comments:
You're being a whiny little bitch :)
I wasn't going to vote for you. But now I will.
“A democracy is nothing more than mob rule, where fifty-one percent of the people may take away the rights of the other forty-nine.”
-Thomas Jefferson
Good thinking. It's only fair.
BC
I've decided that just because I'm the only diabetic in the house, it's not fair that I use all the insulin in the house. You've inspired me. I'll be sharing my insulin with my sisters now.
LOVED IT!...why are people stupid enough to think this will do our country any good???
Mshkosh
I think the billing department should be set up so all the bills are pooled together and those patients who are in the top 5% of income pay 50% of the fees for everyone else, even if they just needed a lab draw or something. That's their patriotic duty.
Wait, I think that already happens. I'll have to double check.
Желаю всего хорошего, comrade.
If The One and his plagiarist veep steal the election, trust me, we're gonna need those opiates you'll be spreading around.
We all desire what's good for the whole, gop-er.
We just don't want to be forced to pay for it at friggin' gunpoint.
The sky is falling!!!! The sky is falling!!!!
At the end of the day you will practice the same old medicine still, gripe about the same frequent fliers and impatient prima donnas in the waiting room, and pay a bit more in taxes while a bunch of us pay a bit less. Mainly we'll all be trying to dig out from under the pile of BS that's accumulated over the last 8 years, and all the redistribution in the world will pale in comparison to that load.
Great post!!To get used to lowest-common-denominator medicine,dictated by bureaucrats who have never made any desicion that didn't involve a focus group;and who read sociology at their community college,come and work a few shifts in an A+E in the NHS!! Breaking TV news here last week was a "new" concept known as 'angioplasty' ...cos...you know...its what 'foreign' docotors do!! Lordy Lordy!!
I love the satire. Few people understand it, fewer can write it this well. Very good. I will link to it.
Hehehehe! SNARKY!
Yep, our country is going to hell in a handbasket.
It IS possible that Mister Obama is the Anti-Christ!
Individualized medicine is clearly only another form of elitism that needs to be abolished.
We need more standardization of medical skills and that may be best accomplished by standardizing medical treatments.
All injuries shall receive a cast. All infections shall receive an antibiotic (within 4 minutes, how long does it take to get a temperature?). All other medical conditions are examples of disloyalty to the state and shall result in deportation.
We need to eliminate specialists. Doctors should not receive any recognition for any specialized skill.
All hail the Proletarianist - the People's Doctor.
Pure genius, comrade. You have a bright future in the party.
Wait - doesn't the hospital industry already do that by refusing to meet adequate staffing numbers in order to maximize shareholder profits. Yeah, you're right, a single-payer health care system would change all that.
Every tax system is a redistribution of wealth. It's just a matter of how it gets redistributed.
Anonymous 1:31 AM,
Are you saying that the government run hospitals do not do the same thing, or that it is OK for government run hospitals to do this, since the government's motives are pure, or something else?
Let's stop assuming government run healthcare is going to be a disaster. So many of the government run programs that have or are failing are due to partisan friction. If we can imagine a political system that actually works together through constructive but positive debate to improve the lives of the American people instead of partisan, political garbage, nay-saying, bitching, and moaning then maybe government run healthcare can work. Imagine a healthcare system whose primary goal was EXCELLENT treatment for EVERYONE no matter what the condition, no matter how serious the problem. Yes, emergencies require triage, but what if there were enough staff to take care of everyone, what if we use better technology to be more efficient, and we provide excellent care to everyone who comes to us for help? Couple this type of healthcare system with an improved education system where we can turn out more highly trained physicians, PA-Cs, nurse practitioners, RNs, etc. to meet the demand we have instead of lowering the quality of service. Add to that an emphasis on research of new techniques, therapies, pharmaceuticals, etc. to create better care and to generate new products which in turn can generate new revenue.
I completely agree that if you think of the VA hospitals or failing social security programs and then apply that ideology to Obama's plans for healthcare it's extremely terrifying. But if you think in terms of the big picture; the drastic change of attitudes and approaches seen in Washington, then maybe there is some hope.
Socialism always fails because there is no free lunch. Just like the lottery is a penalty on people who are bad at math, socialism is a penalty on people who are bad at history. And math too, I guess.
Great satire, Scalpel. I read this out loud to my husband. :) You should check out my story on what happened in Hawaii when free healthcare was offered to ALL the children in the state. 85% of the kids in the new program were previously covered by private plans. Parents who could afford private insurance switched them to the free service to save $55/month. The program was shut down 6 months later.
Daryl, my church group had a serious discussion on that issue. The majority opinion was that he is too f'ing stupid to be the antichrist. One dissenter holds that he won't come into his powers until he is elected president.
But I pay taxes to build a bridge that I never use and yet that very bridge still manages to hold up.
And we can spend 10 billion dollars a month in Iraq but Saddam Hussein never hurt me.
It isn't whether or not socialized medicine will work, it's whether or not we can give it a chance to work, whether or not we can change our attitudes towards it, and whether or not we can work together to make it work.
Private healthcare has failed, and if you can't agree that it's failing, it's getting a 'D'.
I'm willing to admit I don't know that it will succeed. I'm not proficient at statistical analysis enough to understand the hoards of numbers each side flings at other to "prove" it will or will not work. But I don't know that it would necessarily fail either. I know that in very different circumstances socialism as a total approach to government has failed.
I think this is all fine for argument sake. We'll see which direction this country will go in 6 days. I'm confident we're going to elect Barack Obama and he will begin, over the next several years, to transition our country to what I believe will be an exciting new approach to healthcare.
Hopefully we all learned in civics class that no matter what your political allegiance is once the nation has elected a President we follow him and recognize him as our leader. As long as this country does that, I'm happy. You don't have to respect the man but you ought to know enough to respect the office.
You're cherry picking and presenting us with straw man fallacies. Please think outside of the medical profession. Trickle down economics has obviously not been working.
"You're cherry picking and presenting us with straw man fallacies. Please think outside of the medical profession. Trickle down economics has obviously not been working."
Huh?
"Private healthcare has failed, and if you can't agree that it's failing, it's getting a 'D'."
The problem with the statement above is that it doesn't identify the metric. On whose scale is health care failing? I live in the Mid-Atlantic and have resided in zero stoplight communities on up to over 500k people and the one thing that I can see is the disparity within communities. Is this the metric for "failing" in the Commie's eyes? Because things aren't "equal" they must be failing.
As an aside, I once had a friend who taught me the important difference between equity and equality and it is one many of us should learn. While I'm far from consistently being on the same page as Shadowfax (http://allbleedingstops.blogspot.com/2008/10/healthcare-is-not-right.html), I can see eye to eye in that healthcare is a moral obligation. I rank it right up there with charitable donations of time and money and just in general being an active citizen for the improvement of the community. It is compulsory only in as much as the person giving it is doing so of free will. When free will is replaced by forced altruism, the provider and the provider's family are the ones that suffer.
When sums are collected to build up the shared infrastructure or defense of a nation, it's called taxation. When charitable acts are committed under the threat of force or loss, it's called redistribution. This Robin Hood nonsense is gonna kill us all...
"You don't have to respect the man but you ought to know enough to respect the office."
Oh, I see. The same way the liberals/socialist/communists have done for the last 8 years??
JW
BINGO.
I plan to treat The One with the exact respect, regard and consideration that most of the left has for the last eight years.
There's a difference between political dissent and miserable failure.
Perhaps it's because I'm one of these rare Blue Dog Democrats. Perhaps I'm it's because I'm one of these rare conservative Democrats. But I can honestly say that I respect President Bush. I not only respect the office he holds but I do indeed respect him as the President.
We're splitting hairs here. The bottom line -- no matter what ideology you hold -- is that about 50% of this country votes Republican and about 50% of this country votes Democrat. Isn't one of the first lessons our parents teach us is sharing? And isn't it inherent in that principle a notion of cooperation in order to work together to find a common goal and solutions for our problems?
I don't know, I'm tired of the politics. I want my guy to win, but I just want it all to be over and for whoever this country elects to stand up to the American people and give some honest talk. Let's hear some ideas to solve the many problems we face today. And if John McCain is our President-elect in a few short days: I'm happy. Let's just solve these problems. I'm willing to acknowledge our President no matter which side votes him into office.
I think that's what it means to be an American. To cherish honor over ideology. To believe in respect over difference. To be kind and to argue, argue, argue with each other until you cannot breath just to find the perfect answer.
I didn't know that a progressive tax plan equated to Communism. McCain himself has been found on tape promoting the positives of progressive taxation within the past five years. Funny, until McCain got his tit in a wringer with his wholly unqualified show pony VP, the socialism talk never surfaced. Face it, Obama is far and away the best choice for anyone not blinded by party loyality, racism, or outright selfishness. You can decided for yourself which is applicable.
When in doubt, throw the selfish/racism card. After all, it's the universal silencer.
Perhaps we ought to come up with a Law, similar to Godwin's Law: If you holler that criticism of BHO is racist, you've busted out Barry's Law.
Frankly, the increasingly shrill, "If you don't vote for Obama, you're raaaaacist!" is tiresome.
I suspect the next four years will be filled with, "If you don't embrace His proposed Changes, you're raaacist!" and "If you criticize Obama, you're raaacist" is going to be tiresome, as well.
Thankfully, we'll have the Fairness Doctrine to tell us what it's OK to say in public.
Gonzo says:
"Face it, Obama is far and away the best choice for anyone not blinded by party loyality, racism, or outright selfishness. You can decided for yourself which is applicable."
Thank you, Gonzo. Now that I have your logically sound argument to consider, I have seen the errors of my ways. I will now be a good comrade and vote as I have been programmed to. Thank you.
???
How did people suffering from a heart attack become the rich in your analogy? Being the people in most urgent need of assistance, wouldn't they represent poverty-stricken homeless?
Gee, an emergency room doctor. So you don't treat poor people? Or you do? Or you'd rather not? What's your hypocritic oath? "First, check the wallet""
Since taxes are "redistribution of wealth" I presume you don't accept any payment that's been tainted by federal monies.
And when you drive your Lexus to work, I bet you don't drive on roads paid for by taxes. And you only eat food that isn't inspected by the feds because you believe that "redistribution of wealth" is harder to stomach than a bad case of e. coli or salmonella.
And when you hand out medications you don't use FDA-regulated or approved medicines because they've been touched federal monies, right?
I bet you don't even practice medicine with a license, because in order for any government agency to certify you it has to exist, and only exists by virtue of taxes. I'm sure you and your coworkers would never have accepted any federal monies to go medical schools, and I bet the medical school you went to never received federal money.
And I bet when you get time off you protest against our troops because, after all, our military exists only because of that ol' "redistribution of wealth" thingie.
And when someone sticks a gun in your ribs and steals your wallet, you'd never deign to call the cops because, well, those cops, and judges and district attorneys, even the paper that laws are written on, were all paid for by nasty "redistributed wealth".
My guess is that you are a one-way socialist. As long as you're benefiting you have no problem with redistribution of wealth. You don't want to pay anything, just get.
Boy howdy!
“The immediate goal is to make sure there are more people on private insurance plans. I mean, people have access to health care in America. After all, you just go to an emergency room.”
That's your president Bush making your ER room the default insurance policy for the uninsured.
How's that working for you? I take it from your post you don't think it's working at all.
As many have pointed out, you, as an ER doctor, are required by law to treat anyone who shows up at your door, not "the relatively few" who can afford your care. Your hospital then bills everyone who CAN afford to pay a whole lot extra, in order to cover the expenses of those who can't.
You are, in other words, a Communist. So go back to China, jerk. Or stop being an idiot. It's not reassuring to Americans to think their doctors are stupid assholes.
"How did people suffering from a heart attack become the rich in your analogy? Being the people in most urgent need of assistance, wouldn't they represent poverty-stricken homeless?"
If he were to say "I'm going to redistribute some of this pain medication from the rich baroness with a mild headache to the guy with the broken femur", it would seem like a perfectly reasonable thing to do, so he changed the analogy to one that, y'know, doesn't make any sense.
mg here--;
You McCain Palin supporters sound more desperate every day, srsly guys. I'm sorry, you're not gonna win, get the hell used to it, pick a better set of candidates next time.
or don't let your party's representatives fuck up our country so much- you whiny ass old bitches had your way the last eight, it failed, your choice was fail. I'm sorry but you can't expect any of us to feel bad for you, bettar luck next time.
I don't know if you are being serious or not. But if you are, what you said makes no sense.
1. Since you don't deal with payment, you aren't in a position to ration based on who can pay and who can't. Your administrators are in that position.
2. If you are concerned about abusive use of the ER, does it really matter whether the payment is coming from the person and his/her employer, the hospital, or the government? Isn't wasteful care still wasteful?
3. Are you saying that a poor person with a heart attack deserves less attention than a rich person?
4. Single payer is exactly that...PAYER. The provider is that same whether its McCain or Obama's plans, i.e. its you, working for your privately owned hospital. Patients get to keep their current doctors either way.
As an emergency physician, it is your job to provide the best care for ALL patients regardless of income, race, gender or political affiliation. If you have a problem with this approach, then you are in the wrong career pal.
I am sure you can find a position with a health insurance company that gives incentives to physicians for denying patient claims though. You have the small heart for it.
Ezra Klein has the following answer to you at his blog:
http://www.prospect.org/csnc/blogs/ezraklein_archive?month=10&year=2008&base_name=department_of_unintended_irony#110495
First of two paragraphs of Klein's post:
The ER is the most Marxist building in the modern American hospital. By law, it treats anyone who decides to bleed in the waiting room, no matter their ability to pay, thus fulfilling the "from each according to his ability" requirement. It parcels out medical attention based on severity of condition rather than thickness of wallet, thus fulfilling the "to each according to his need" requirement. It's a socialists redoubt in a capitalist system.
It is amazing how few people understand satire.
Where was Dr. Scalpel actually advocating not treating sick people?
Where is Dr. Scalpel making any kind of racist statement?
Bob in Pacifica makes the argument - this is the way the government currently running thing, you live in this country, therefore you are the reason things run this way and you are being a hypocrite for not admitting that it is all your fault. You are a hypocrite for trying to change anything according to this attempt at logic.
Brooksfoe just demonstrates childishness.
Anonymous 12:27 just does not get the satirical analogy.
Adam does not recognize the satire, but presumes that all hospitals are privately owned, or at least that Dr. Scalpel's hospital is. This does not really matter, since both can provide bad care for selfish reasons. The suggestion that government control eliminates selfishness is not at all logical. If it were true, people in government would never make headlines for corruption, government contracts would always come in on time and on budget, care at government hopsitals would be far superior to any private hospital - the only reason to go to a private hospital would be for the amenities.
Anonymous 12:34 is another who does not recognize satire.
This post is an example of satire. Perhaps you might understand satire more if you read Jonathan Swift's A Modest Proposal.
I don't think liberals understand satire.
But it's cool that Klein linked here. I was wondering where all those sinister commenters came from.
Rogue Medic:
It's possible both to understand satire and recognize very poorly done satire, that in no way conveys what it was seemingly intended to convey.
Swift's writing is satirical, but it's also coherent. This post is satire, sure. It's just exceedingly shitty satire.
Maybe it's the ER they don't understand then.
I posted this comment at Klein's:
Thanks for the link. To understand my post, you have to understand the Designers Holy Triangle. But since I don't get to set the rates for my services, you really only get to pick one....fast or good. And usually you don't get to choose, I do.
Of course I treat all comers regardless of payment, but the one thing over which I have control in my little Marxist world is the effort I put into each interaction. I can make you the plain Swiss Miss powdered cocoa mixed with hot water or the Ned Flanders special. Either way you still get served, right?
Anonymous 03:06,
One of the best ways to determine the quality of satire is the outrage in responses from those with different points of view.
Using that metric, this clearly is high quality satire. The responses resort to obscenity, name calling, and even attempts to point out possible inconsistencies in the satirical piece.
It is satire.
Apparently the liberal commenters, in their need to debase this satire, actually give it very high marks.
I agree. Great satire Dr. Scalpel.
wow, if that was satire, it was really bad. I think it probably was not however, just so bad that the only defense was to call it satire after the fact. That doctor is most likely just a really bad human being who got into the profession for the money, ala Frank Burns.
Ah, Rogue Medic...arguing with such people is like putting lipstick on a pig, and then trying to teach it to dance.
You get frustrated, and chances are, the pig gets off on it.
One of the best ways to determine the quality of satire is the outrage in responses from those with different points of view.
Okay!
God can only hope these douche jockeys are not breeding.
Anonymous 04:25,
You make my point and seem not to understand the dufference between liberal and literal.
Cranky,
At least dancing pigs help me to feel that I can dance.
Anonymous 0525,
You understand satire and understand that the best way to respond to satire is with satire. You made me laugh.
I expected a few more visitors from that link. I got more referrals from Dr. WhiteCoat when he first linked to this post.
Whitecoat, you should tap into some of those sweet advertising bucks.
What scalpel doesn't understand is that Bush has never been a fiscal conservative in the true sense of the word. Bill Clinton was much more fiscally conservative than Bush ever was. Yes it is truly hard to give a tax cut to the wealthy and ignore a ballooning deficit via writing IOU's to the chinese. I honestly believe scalpel wouldn't know a true fiscal conservative or liberal if it bit him in the ass. Just as long as it happens to where the republican sticker, it is good enough for him. What a non-thinking ideologue
"Every man cannot have his way in all things. If his opinion prevails at some times, he should acquiesce on seeing that of others preponderate at other times. Without this mutual disposition we are disjointed individuals, but not a society." -- Thomas Jefferson to J. Dickinson, 1801.
Just be sure, when you're deciding whether to give your patient swiss miss or flanders cocoa that you're not running afoul of these. (Some of your assertions lead me to suspect that you may be):
I. PRINCIPLES OF ETHICS FOR EMERGENCY PHYSICIANS
The basic professional obligation of beneficent service to humanity is expressed in various physicians' oaths and codes of ethics. In addition to this general obligation, emergency physicians accept specific ethical obligations that arise out of the special features of emergency medical practice. The principles listed below express fundamental moral responsibilities of emergency physicians.
Emergency Physicians Shall:
1. Embrace patient welfare as their primary professional responsibility.
2. Respond promptly and expertly, without prejudice or partiality, to the need for emergency medical care.
3. Respect the rights and strive to protect the best interests of their patients, particularly the most vulnerable and those unable to make treatment choices due to diminished decision-making capacity.
4. Communicate truthfully with patients and secure their informed consent for treatment, unless the urgency of the patient's condition demands an immediate response.
5. Respect patient privacy and disclose confidential information only with consent of the patient or when required by an overriding duty such as the duty to protect others or to obey the law.
6. Deal fairly and honestly with colleagues and take appropriate action to protect patients from health care providers who are impaired or incompetent, or who engage in fraud or deception.
7. Work cooperatively with others who care for, and about, emergency patients.
8. Engage in continuing study to maintain the knowledge and skills necessary to provide high quality care for emergency patients.
9. Act as responsible stewards of the health care resources entrusted to them.
10. Support societal efforts to improve public health and safety, reduce the effects of injury and illness, and secure access to emergency and other basic health care for all.
I don't see anything there about adding whipped cream with sprinkles and a cherry on top.
When incentive is taken away by socialism, eventually some docs may decide to dispense with the hand-holding, with the listening, with the detailed explanations, with the TLC that separates the exceptional physician from the average.
And yet they may still be basically competent and perfectly ethical. Just not exceptional.
In my EW we've found that listening to the patients has been a necessary precondition to accurate diagnosis and appropriate treatment.
My residents who try to manage their patients without listening to them tend not to fare too well.
My residents had better offer explanations that are detailed enough to obtain an adequately informed consent from every patient.
If these are the whipped cream and a cherry on top of treatment then they better be on every cup that is provided. The doc who doesn't listen and doesn't inform is putting their license and livelihood at risk, to say nothing of ethical responsibilities.
Residency is sort of an artificial situation. In the real world, without anyone looking over their shoulder, many of your former residents are listening to half a sentence before interrupting and plowing on to the abbreviated and cursory physical exam and inevitable CT scan. They usually leave the re-assessments to the nurses, and they may or may not give verbal discharge instructions.
When pressed for time, most of us cut corners a bit. Where and how much we cut them vary considerably.
The ER is an impossible situation. We do our best to make things work as well as they can work, given the impossible ratio of unlimited need to highly limited resources.
And this is just my point. If one were to choose to provide extra attention to some patients (whipped cream and a cherry) in a situation where cutting corners is the unfortunate but necessary norm, then medical necessity had better be the primary determinant of who gets extra attention.
So then we are back to Mr. Klein's assertion that the ED "parcels out medical attention based on severity of condition rather than thickness of wallet, thus fulfilling the 'to each according to his need' requirement. It's a socialists redoubt in a capitalist system."
In the ED situation, the doc who looks to ability to pay rather than medical necessity in determining the allocation of his limited resources of time and energy is not unlikely to be running into conflict with the rules of medical ethics.
I think you're on to something. You may have figured out the only way to make universal coverage work. (Said a Dem who's not buying the party line on health coverage. I'm still voting Obama, though, all things considered.)
Like most conservatives, scalpel fails to understand that "being a prick" is not equal to "satire".
Your opening, which the rest of the "satire" rides on:
"Since it appears that America is headed towards obligatory Socialism courtesy of our imminent Democrat overlords..."
This is more Sarcasm than it is "satire". And if it is satire, it is still mocking socialist/democratic ideals. Therefore anyone who disagrees with you is justified. Don't tell me I don't know what satire is. I'm working on a degree in literature. I know full well what satire is. This post was having fun at the expense of Obama supporters, and is laced with your opinions.
Its disturbing to think so many good men have died in battle to defend democracy and a free market economy to only have that entity the defended elect someone who is in direct contradiction of their purpose of service.
As for the ER, I agree. But with a nationalized healthcare system you may now be required to dedicate some of your time to other services. Hell the ER may just shut down or worse, be run by surgery...!
Anonymous 08:39,
"Don't tell me I don't know what satire is. I'm working on a degree in literature."
From the OED
Satire
"I. 1. A poem, or in modern use sometimes a prose composition, in which prevailing vices or follies are held up to ridicule. Sometimes, less correctly, applied to a composition in verse or prose intended to ridicule a particular person or class of persons, a lampoon."
I guess that is my example of irony. :-)
Anon writes: "so many good men have died in battle to defend democracy and a free market economy..."
To die for love of country, liberty, family, home, democracy, God, and a million other things, sure. But the free market economy? When have Americans been asked to give their lives to safeguard the free market economy?
Giving less opiates to more people is not being more generous... true generosity would be if you gave free IV hydromorphone 8mg to everybody coming in, whether they want/need it or not. Hell, if you had that kinda policy, I'd drive all the way from Canada to get "treatment"!
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